There is no clear definition of “quackery”. Stephen Barrett, founder of Quackwatch, discusses the slippery nature of the definition and the issues of intent and competence. Defining quackery of necessity involves some subjective judgment, but there are objective parameters we can apply. If someone is hyping a medical practice without adequate scientific evidence and is profiting from it, they are a quack.

Quackery differs from “fraud”, which is a legal concept. In my state health care fraud is defined as:

Intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable Federal or State law.

Additionally, “abuse” is defined as:

Provider practices that are inconsistent with sound fiscal, business or medical practices, and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the Medicaid program

What’s harder to nail down is exactly what practices short of fraud and abuse can lead to disciplinary action. As Brother Orac has pointed out, state medical boards, which are responsible for physician discipline, are problematic institutions, usually willing to give doctors the “benefit of the doubt” when it comes to defining “professionally recognized standards.”

So what to make of doctors who promote, for whatever reason, patently false health information and practices?

Commonly, doctors who promote unscientific health practices and ideas inhabit an ambiguous universe. Most health professionals see them as quacks, but their own patients/victims often see them as saviors. The fact that they may be revered does not, of course, make them right, but it is important. Anecdotes from satisfied marks are very powerful, often more powerful than expert knowledge. This can lead to a “credibility feedback loop”, where satisfied customers give anecdotes, which are confirmed by pseudo-experts, who are further lauded by laypeople, adding to their pseudo-credibility.

This is the quality of expert seen at the Medical Voices Vaccine Information Center. This new organization, with its slick website and massive appeal to authority is a collection of the nations most famous anti-vaccine cranks. Their qualifications come not from their work in infectious disease, immunology, or epidemiology, but in fear-mongering and paranoia. Each of the claims on the front page of their site is either patently false or gravely deceptive.

For example, their first bullet point claims:

Real doctors: Medical doctors speak the truth about vaccines. Medical doctors convey the results of thousands of hours of study

This implies that all other doctors convey untruth about vaccines. And this “thousands of hours of study” is meaningless. What kind of study? Does a few hours of reading by a small group of cranks trump centuries of bench and clinical research? The answer is clear in the next bullet point:

The absurdity of this claim is overwhelmed only by its audacity. Vaccines have never eradicated a disease? Smallpox is the best example of complete eradication, but local control or eradication of infectious diseases has been accomplished over and over, with diseases such as polio, measles, mumps, Haemophilus influenzae type b (Hib), and many others. How do they counter such well-grounded facts? It’s not by science:

Vaccination does not equal immunization. Lifetime immunity is only conferred by natural exposure.

This is either a horrible misunderstanding or a lie. Different vaccines confer immunity for different amounts of time. The pertussis vaccine, for example, protects small children, those most vulnerable to the effects of the disease. Boosters can protect adults. The alternative, as they imply, is to become vaccinated naturally by contracting the disease. If the disease were the common cold, great, no problem. For pertussis or Hib, this can mean severe debility or death, just to satisfy some cranks ungrounded beliefs.

Independent of whether this new organization should be labeled “quackery” or “fraud”, it’s a danger to public health. It’s a self-serving, quasi-religious front for disease promotion, akin to Scientology, or to Nemenhah, the cult behind the death of a young diabetic girl in Wisconsin. The tell is their claim that “natural infection” is required for “real” immunity. These people want your children to become ill and possibly die. That is unforgivable.

Wow, thats some strong crazy at medical voices. If these folks aren’t frauds then they are so incredibly incompotent that they should never, under any circumstances, be allowed in the same room as a sick person. Exactly how far does a doctor have to go before a medical board will intervene?

According to the latest bulletin issued by Medicins Sans Frontieres (no. 143 bis, August 2009, page 14) every year measles kills more than 200,000 individuals in the world, principally young children in poor countries. The danger is a very real one.

When I was a kid – in the ’60s – I don’t recall ever coming across a contemporary with smallpox or polio. More recently, amongst my neices and nephews and their contemporaries I haven’t heard of measles, mumps, rubella or whooping cough showing up.
Oh: and I don’t know anyone who’s sufferred from Tetanus.

Lessee… in the 70’s I had measles and chicken pox. I was lucky and only got a few scars. But then when I was studying for my medical degree, ironically enough during my neuro section, I got shingles.

Shingles hurts. A lot.

I never knew anyone as a kid who got smallpox (obviously) or polio. But I have treated lots of people with post-polio syndrome.

When I went to Africa, I saw a teenaged girl die of rabies. We had several babies come in with neonatal tetanus, lost causes. Measles outbreaks were common. Polio was on the downslope due to massive international eradication efforts (read: vaccination) but there were a huge number of people with paralytic damage. Vaccines are not preventing anything? Seriously?

These nutjobs need to go to, say, Tanzania, and decide whether or not they really want a yellow fever shot.

I think the anti-vax movement is akin to the anti-free market movement and the anti-union movement in that it builds upon the tendancy of those who inherit wealth to forget/ignore how the wealth came to be.

Here in the USA we enjoy a very high level of good health, due mostly to the hard work of public health efforts of the previous centuries. But, thinking what we have been born into is normal, people disparage the efforts that got us here, and feel that biting the hand that feeds them makes them “radical” and “revolutionary.”

The last time I checked, getting a full-blown case of tetanus does not protect you from getting tetanus again. The only way to protect against tetanus is to live in a bubble or get the tetanus immunization series with boosters.

Fricking idjits. Now I’m going to spend the rest of my clinic more grumpy than I already am. I also want to know if medical doctors speak the truth about vaccines why do their medical doctors trump all the medical doctors in my clinic, at the CDC, or anywhere who think that vaccines are a good thing.